Aortic valve (AV) calcium quantification by cardiac Computed Tomography (cardiac CT) has been proposed as an alternative for AV stenosis quantification when echocardiography is uncertain. To limit X-ray radiation and cost, we developed an alternative AV calcium score based on 3D-transesophageal echocardiography (3D-TOE).

The study enrolled 29 patients referred for AV assessment (21 men and 8 women who were 78±11 years old, average transaortic peak velocity was 4.18±1.5m/s and average mean transaortic gradient was 45±18mmHg). All patients underwent 3D-TOE and calcium score was derived from AV 3D full volume data using home-made region growing algorithm developed on MatLab^® (Fig. 2). Calcium score obtained with 3D-TOE was compared to AV calcium scoring obtained by cardiac CT. In patients referred for cardiac surgery, AV calcium scoring by CT was repeated on the explanted AV and calcium weight was obtained by pathology analysis.

Calcium score by 3D-TOE (8877±4024 AU) and CT (3155±2360 AU) were fairly correlated (R=0.88; P<0.0001) (Fig. 1). Similar correlation was observed with CT calcium score on explanted AV (R=0.89; P=0.0014) and pathology data (R=0.63; P=0.0516). Inter-observer and intra-observer variability coefficients were 11% and 11%, respectively (Fig. 1, Fig. 2).

AV calcium load can be quantified using 3D-TOE. Excellent correlation was observed with AV calcium score obtained by CT.